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Intestinal polyp
Last reviewed: 12.07.2025
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An intestinal polyp is any growth of tissue from the intestinal wall that protrudes into its lumen. Most often, polyps are asymptomatic, with the exception of minor bleeding, which is usually hidden. The main danger is the possibility of malignant degeneration; most colon cancers arise from benign adenomatous polyps. The diagnosis is established by endoscopy. Treatment of intestinal polyps is endoscopic removal of polyps.
Polyps may be sessile or pedunculated and vary considerably in size. The incidence of polyps ranges from 7% to 50%; a higher percentage are very small polyps (usually hyperplastic polyps or adenomas) found at autopsy. Polyps, often multiple, occur most commonly in the rectum and sigmoid colon and decrease in frequency proximal to the cecum. Multiple polyps may represent familial adenomatous polyposis. Approximately 25% of patients with colon cancer have associated adenomatous polyps.
Adenomatous (neoplastic) polyps are of greatest concern. Such lesions are classified histologically as tubular adenomas, tubulovillous adenomas (villoglandular polyps), and villous adenomas. The likelihood of malignancy of an adenomatous polyp within a period of time after detection depends on the size, histologic type, and degree of dysplasia; a 1.5 cm tubular adenoma has a 2% risk of malignancy versus a 35% risk for a 3 cm villous adenoma.
Nonadenomatous (nonneoplastic) polyps include hyperplastic polyps, hamartomas, juvenile polyps, pseudopolyps, lipomas, leiomyomas, and other rarer tumors. Peutz-Jeghers syndrome is an autosomal dominant disorder with multiple hamartomatous polyps in the stomach, small intestine, and colon. Intestinal polyp symptoms include melatonic pigmentation of the skin and mucous membranes, especially the lips and gums. Juvenile polyps are seen in children and tend to outgrow their blood supply and self-amputate over time or after puberty. Treatment is required only for bleeding that does not respond to conservative therapy or for intussusception. Inflammation of the polyps and pseudopolyposis are seen in chronic ulcerative colitis and in Crohn's disease of the colon. Multiple juvenile polyps (but not single sporadic polyps) increase the risk of developing cancer. The specific number of polyps that results in an increased risk of malignancy is unknown.
[ Symptoms of intestinal polyp
Most polyps are asymptomatic. Rectal bleeding, usually occult and rarely massive, is the most common complaint. Crampy abdominal pain or obstruction may develop with large polyps. Rectal polyps may be palpable on digital examination. Occasionally, polyps with a long stalk prolapse through the anus. Large villous adenomas sometimes cause watery diarrhea, which may lead to hypokalemia.
Diagnosis of intestinal polyps
Diagnosis is usually made by colonoscopy. Barium enema, especially with double-contrast, is informative, but colonoscopy is preferred because of the possibility of removing polyps during the examination. Since rectal polyps are often multiple and may be associated with cancer, a full colonoscopy to the cecum is necessary, even if a distal colon lesion is detected with a flexible sigmoidoscope.
What do need to examine?
How to examine?
Treatment of intestinal polyps
Colonic polyps should be completely removed using a snare or electrosurgical biopsy forceps during total colonoscopy; complete removal is especially important for large villous adenomas, which have a high malignant potential. If colonoscopic removal of the polyp is not possible, laparotomy is indicated.
Subsequent treatment of intestinal polyps depends on the histological evaluation of the neoplasm. If the dysplastic epithelium does not penetrate the muscular layer, the resection line along the polyp stalk is clearly visible, and the lesion is clearly differentiated, then endoscopic removal is performed, which is quite sufficient. In case of deeper epithelial invasion, unclear resection line or poor differentiation of the lesion, segmental resection of the colon should be performed. Since epithelial invasion through the muscular layer provides access to lymphatic vessels and increases the potential for lymph node metastasis, such patients should undergo further evaluation (as in colon cancer, see below).
The definition of follow-up examinations after polypectomy is controversial. Most authors recommend performing total colonoscopy annually for 2 years (or barium enema if total colonoscopy is not possible) with removal of newly detected lesions. If two annual examinations do not reveal new lesions, colonoscopy is recommended thereafter once every 2-3 years.
How to prevent intestinal polyps?
Colon polyps can be prevented. Aspirin and COX-2 inhibitors may be effective in preventing new polyps from developing in patients with colon polyps or colon cancer.